MD's told to ‘Avoid drugs’ for Lowback Pain

In an update to a report issued 10 years ago, the American College of Physicians (ACP) published a meta-analysis on the treatment of low-back pain. The study, released on February 14, 2017, is in the form of guidelines directed toward “all clinicians” and the patient population suffering from acute, subacute, and chronic low-back pain. In this terminology, “acute” stands for pain lasting fewer than four weeks, “subacute” for pain lasting from four to 12 weeks, and “chronic” meaning pain lasting more than 12 weeks. The researchers conclude their findings with three recommendations, based on their assessment of evidence-based outcomes for the patient population with respect to standard noninvasive approaches to treatment. Namely, they examined how patients responded to pharmacologic treatment and nonpharmacologic treatment; in other words, Standard Allopathic Medicine and Complementary and Alternative Medicine (CAM) like chiropractic care. The ACP recognizes that low-back pain is one of the most common health complaints in the U.S., and cite statistics with which every doctor of chiropractic (DC) is intimately familiar. They estimate the total cost (in 2006), between active care and lost productivity, to have been approximately $100 billion—a number likely to be considerably higher today. In looking at pharmacologic approaches to low-back pain treatment, acetaminophen was found to be on a par with placebo, offering little benefit but presenting known risks of liver damage. Other drugs, ranging from cox-2 inhibitors to NSAIDs to opioids, offered slightly greater benefits but with higher pronounced risk. On the other hand, when looking at nonpharmacologic approaches, including exercise, acupuncture, massage, chiropractic, ice/heat therapy, low level laser therapy, and others (tai chi, yoga, ultrasound, etc.), measurable positive outcomes were found with virtually zero risks. The researchers concluded that, given the evidence at hand in the new study and in the older one, that treatment should always begin with nonpharmacologic approaches first, and only those patients who are nonresponsive to them should be considered for drug therapy or invasive medicine. Specifically, the three recommendations of the study authors are: 1. Given that most patients with low-back pain of any type tend to improve over time regardless of treatment type, they should first turn to the most conservative forms of care (massage, chiropractic, etc.), and NSAIDs and muscle relaxants can be considered if necessary. 2. For patients with chronic low-back pain, the first option should be nonpharmacologic conservative care. Patients in this group respond more strongly to alternative care like chiropractic care than those in the acute and subacute groups. 3. Patients with chronic low-back pain who fail to respond to nonpharmacologic approaches could consider pharmacologic treatment, starting with those products known to present the least risk, and after being educated by their provider about the known risks posed by such products. These recommendations are in keeping with the Hippocratic Oath: First, do no harm. **It is noteworthy to see an MD association admit that CAM approaches compared to medical care—and here specifically chiropractic is included—offer superior outcomes to standard allopathic medicine. These results were striking enough that they were summarized in the February 14, 2017, edition of the Wall Street Journal (“No Drugs for Back Pain, New Guidelines Say: The American College of Physicians says to use natural and alternative therapies first”). Source: Chiropractic Economics, 3/19/17.

10 Things Happy Couples Do When They Fight, According To Experts

No relationship is perfect, and every couple has their own share of ups and downs. However, what separates happy couples from miserable couples is how arguments are handled. There a number of things happy couples do when they fight that make their arguments more productive and less hurtful, and knowing these behaviors can help you improve your own relationship as well. All couples are unique, but certain habits prove to be more effective when it comes to disagreements. Contrary to what you might believe, fighting — the proper way — can actually be healthy and strengthen your relationship. “When couples have fights, that is a sign that they feel comfortable enough to express their differences without feeling like their entire relationship could implode,” says relationship expert Megan Stubbs, EdD, ACS. “When one party constantly goes along with what the other does, it can be a sign that they don't feel secure in the relationship. They don't want to upset the status quo for fear of the repercussions.” Bottling up your feelings isn’t right, but neither is exploding on your partner and making them feel bad. If you feel like your fights are more destructive than productive, try paying attention to these nine things that happy couples do when they fight. 1) They Avoid Name Calling Calling your partner stupid or insulting them only adds fuel to the fire, and it won’t help resolve anything, no matter how upset you are. “When happy couples fight, they make sure to keep whatever issue they are fighting about at the forefront and won't use name calling to bring their partner down,” says Stubbs. 2) They Stay Focused In The Present Happy couples avoid bringing up past discretions, especially if they’re not relevant to the argument. “If something has been put to rest, they don't bring it up to gain the upper hand of a fight,” says Stubbs. Focus on the issues at hand instead of digging up sensitive moments from the past. 3) They Look For Compromise Looking for compromise is essential, and attentively listening to your partner can help you get there. “Ultimately they know that they are a team and that despite their differences, their relationship is (hopefully) greater than the conflict,” says Stubbs. 4) They Keep It Between Themselves “In a healthy relationship, no one is taking their fight to social media or engaging friends or family to have someone on their side,” says psychologist and relationship expert Antonia Hall, MA over email. “Happy couples know that they are a team, and if they want to make the relationship work, they have to work things out with each other.” 5) They Work Through It Right Away “Taking a little time to regroup, gather one's thoughts and calm down is a healthy part of working through disagreements, but letting things carry on unresolved for days isn't,” says Hall. “In a happy relationship, couples work things out in a timely manner so they don't escalate and they get back to enjoying each other faster.” 6) They Accept Apologies When a partner offers a sincere apology, the other person is willing to accept it instead of holding onto anger or hurt. “Trying to hold something against one's partner only creates more pain and distance,” says Hall. “In a true partnership, couples apologize and forgive one another.” 7) They Avoid Interrupting During a fight, happy couples let their partners express their feelings without interruption. “Just listen,” says relationship expert Audrey Hope over email. “Things will calm down, but first hear each other. If your significant other is taking time to scream, shout or make a point, then there must be a good reason. Allow the madness. It can only lead you to a better understanding.” 8) They Admit When They're Wrong “Stop having to be right for a change,” says Hope. “What is winning after all, if you lose the one you love? Accept, surrender and know that laying down the armor in a fight is actually a win.” 9) They Avoid Generalizations Happy couples avoid using phrases like “you never,” or “you always.” “Generalizations don't help address the specific issue at hand,” says Stubbs. Focus on explaining how that person made you feel in this specific instance. 10) They Respect When The Fight's Over “Once a disagreement is resolved, loving partners don't continue to bring them up over and over again,” says Hall. “Committed sweethearts get their points across, hear one another, forgive, and move on.” Source: CARINA WOLFF, Bustle, 3/4/17.